It is fundamental that anyone who goes to a therapist is there to get help with their own problems, not to be a solution to the therapist’s. Practice guidelines and ethics forbid therapists from violating boundaries, and part of that, no matter whether you are being seen by a PhD, LCSW, Psychiatrist, or any other type of counselor, is that they are proscribed from disclosing much in the way of details about their personal life. That’s because such self-disclosure can, at a minimum, inhibit the patient’s progress by blurring the lines of the therapeutic relationship and, at a maximum–as in the story you are about to read–be psychologically damaging.
Forensic psychiatrists Dr. Paul Appelbaum and Dr. Thomas G. Gutheil identify avoidance of exploitation and boundary maintenance as primary to prevention of negligence and malpractice claims:
The clinician should avoid any manner of exploitation of the patient. To do otherwise would violate the principle of fidelity to patients’ interests and clinicians’ fundamental ethical principle, primum non nocere, ‘first, do no harm.’ This approach should include avoiding . . . subtle exploitation of the patient’s feelings (e.g., using the patient to express one’s dependency needs, one’s wish to be liked, or one’s wish to control others). . .
One of the most important concepts for the clinician is that of boundary violations. A boundary is the edge of appropriate behavior. The boundaries in question are the boundaries of the professional role and of the clinician-patient relationship, based on the recognition that this relationship represents a power asymmetry (the clinician has the power to do certain things to, and with, the patient that the patient does not have toward the clinician). . .
Boundary crossings represent deviations from ordinary therapeutic practice but are helpful and not harmful to the patient; they may advance or even enable the therapy. Examples include offering a crying patient a tissue (although that is not talk therapy), helping up a patient who has fallen (although that involves touching the patient), and telling a patient how to reach you in an emergency (although that constitutes self- disclosure).
Boundary violations, however, are distinguished by the fact that they cause harm to the patient, most commonly through some form of exploitation. Examples include . . . using the patient essentially as one’s own therapist by disclosing one’s emotional problems, personal issues, and psychological conflicts to the patient, a phenomenon called role reversal. In each of the last examples and the many others seen in litigation, the therapist’s needs, goals, and wishes are served rather than the patient’s-hence the exploitation.
Some common boundary violations include . . . shifts in the relationship such that some ambiguity intrudes as to who is therapist and who is patient (e.g., clinicians’ self-disclosure of significant personal details including those about their social, financial, and sexual difficulties -presumably in the interest of having the patient console them, or at least listen sympathetically, a role-reversal in which the patient is taking care of the clinician).”
Paul S. Appelbaum, M.D. and Thomas G. Gutheil, M.D., Clinical Handbook of Psychiatry & the Law, p.142-43, (4th Ed.) (2007).
There are real psychological consequences when a therapist breaks these boundaries, even when it is emotional and not physical.
Even without overt sexual contact, boundary breakdowns can lead to damages similar to those seen when the relationship becomes sexual (Schoener et. al., 1989, pp. 133-147; Simon, 1991): The failure to render needed therapy–undermining what good work may have been done; Failure to refer for other services–the psychotherapist “hanging on” to the client and trying to provide for all of his or her needs; Creation of unhealthy dependency which is difficult to resolve; Confusing the client about what is therapy and what is personal; Breach of trust–client distrusting professionals as a result of the corruption of the therapy; In some instances, interference in family relationships, friendships, etc.; Anger, loss of self-esteem, depression, and other psychological distress.
– Gary Richard Schoener
And one from someone who specifically studies the harm caused by psychotherapists violating boundaries (the entire paper, Boundary Violations in Therapy: The Patient’s Experience of Harm, is excellent and can be found here):
Boundary violations in psychotherapy are associated with a range of potential harms to clients, including emotional distress, feelings of betrayal, loss of trust, damaged self-esteem, and symptom exacerbation…. Therapists who engage in boundary violations often rationalize their behavior and fail to appreciate the harm it can cause. Clients may experience boundary violations as a form of abuse or re-traumatization…. Another common way in which therapists side-step responsibility is by insisting that patients’ complaints are re-enactments of childhood trauma rather than a here-and-now response to unsatisfactory therapist actions.”
– John Hook and Dawn Devereux
Hook and Devereux’s research has identified certain personality traits and dynamics that may predispose some therapists to crossing ethical boundaries. One concerning phenomenon is “adverse idealizing transference,” where the therapist becomes overly idealized by the patient. This can lead the therapist to feel a need to maintain that idealized status, potentially through inappropriate self-disclosure or other boundary violations. As Hook and Devereux explain, “Adverse idealizing transference occurs when the therapist becomes intoxicated with the patient’s idealization and loses the capacity to maintain appropriate boundaries.”
Additionally, therapists who struggle with their own unmet emotional needs, feelings of inadequacy, or a desire for control may be more prone to exploiting the patient relationship to fulfill those internal drives. A lack of self-awareness, poor boundaries, and an inflated sense of their own importance can all contribute to a therapist’s willingness to violate professional ethics. As Epstein and Simon (1990) found, “Psychiatrists who violated boundaries scored higher on measures of narcissism, exploitativeness, and boundary turmoil” (Gabbard & Nadelson, 1995).
The harms I experienced largely mirror those described by Schoener, Hook & Devereux. I don’t think it had to turn out that way, although maybe I’m fooling myself. I do think that what my therapist did she should not have done, but having crossed the line the true harm came from her dancing back and forth across it while telling me I had to stay on my side. I became, in my perception, a helpless character in my own story.
I have some theories as to why she did this, but I’ll let those unfold with the story.
Boundary Violations in Psychotherapy - A Personal Case Study 